Doc: Gallbladder removal didn’t stop stone formation


Dear Dr. Roach: My husband had his gallbladder removed many years ago. In the past few years, he has had six ERCPs to remove gallstones from his bile duct, as he is still making them. He has been told to drink lots of water but that there is no preventive remedy. Do you have any suggestions for how to prevent these gallstones from forming?

— B.A.P.

Dear B.A.P.: Ordinarily, removing the gallbladder stops new gallstones from forming. Having a gallstone left after surgery is not uncommon, but it is very uncommon for people to make multiple new stones years after surgery.

One possibility is a diverticulum of the common bile duct. The common bile duct drains bile from the liver and gallbladder into the small intestine; it drains pancreatic fluid, too. A diverticulum is a blind pouch. It’s possible for a stone to form there, so you should find out if he has one. They should have seen it on one of the ERCPs (a special endoscopy that looks at the bile and pancreatic ducts). If present, a diverticulum can be removed surgically.

I asked my colleague at Weill Cornell, Dr. Arun Jesudian, for his expertise, and he said he has seen multiple stones in the liver due to parasitic infections, often in Asian patients. That may require surgical treatment. He also discussed doing a sphincterotomy, which is a procedure to open the end of the common bile duct, to let stones pass through easily. Your husband may benefit from expanding it. Finally, there is a medication to reduce gallstones, ursodiol (Actigall), which Dr. Jesudian feels had no real downsides and might well help.

Dear Dr. Roach: I’m a female, 53, who suffers from and is being treated for IBS. I have a history of colon cancer in my family. My family members and I go through regular screenings and so far, we’ve been clean. Once in a while, I wake up feeling a sharp, stabbing pain in my rectal area that lasts no more than 20-30 minutes before going away. These pains occur no more than once a month, sometimes every few months, but the pain often happens while I’m asleep and wakes me up. Luckily, there have been no bloody or black stools or urine following this, much to my relief. I’ve talked to my gastroenterologist about it, and he’s as clueless as I am. I do exercise and watch what I eat. Could it be gas? At least the pain is short-lived, so it doesn’t interfere with my daily activities or routine.

— A.

Dear A.: Irritable bowel syndrome is a common problem, found more frequently in women, that ranges from annoying to life-changing. Although it does not predispose to cancer or reduce life expectancy, IBS can have dramatic effects on a person’s social and work lives.

The hallmarks of IBS are bowel changes (diarrhea, constipation or sometimes both, alternating) and abdominal discomfort. The discomfort is usually described as cramping, but it is not unheard of to be described as sharp or stabbing. I believe a colonoscopy is appropriate to be sure IBS is not actually a different problem, such as inflammatory bowel disease. Black or bloody stools would be concerning for IBD not IBS.

Your symptoms are not typical for colon cancer, which often has no symptoms until it is quite advanced, making regular screening is so important.

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